A common problem facing bedbound people is decubitus ulcers otherwise known as pressure sores. A pressure sore can occur whenever a bony prominence of a person is subjected to unrelieved pressure. This pressure causes reduced circulation and eventual skin breakdown. An ulcer can occur in as little as a few hours if conditions are right. The sore(s) will start with what appears to be a simple bruise, but if pressure is unrelieved, it can lead to a sore that can go deep into the soft tissue, and if not adequately addressed, the pressure will cause the sore to open all the way to the bone.
Persons who are bed bound or chair bound, have compromised skin integrity due to poor health, and/or is desensitized from anesthesia, pain medication or neurological impairment, are prone to pressure ulcers. It is a common occurrence in the hospital setting, especially for those in long term care and those who are subject to long operations in where they are not moving naturally. Hospital management has a strong incentive to prevent such sores and the infections that may arise there from, as they can be costly for all involved.
The most common spots for pressure sores are the heel of the feet and the sacral/coccyx area of the lower back, because these spots are difficult to support without pressure and there is only a thin layer of skin over these bony prominences. To minimize the pressure to the lower back, the care giver must shift the patient frequently by “turning” them from side to side so that they do not stay on any one pressure point for an extended time. As for the feet, the standard of care is to “float” the heels off the surface of the bed by tucking pillows under the persons lower legs so that the heels do not touch anything.
Standard pillows and foam wedges have been used to “float” the heels off the surface of the bed. However the use of standard pillows and known foam wedges to float the heels suffer from a number of problems.
Standard pillows, although soft and malleable making it easy for a care giver to “shape” the pillows so that they can accomplish “floating”, are inadequate for the long term because the soft pillows cannot hold the shape the care giver fashioned. Additionally, the pillows tend to slip out of place or “bottom out” under the weight and natural shifting of the patients' movements. Frequently one will find direct pressure from the pillow itself only a few minutes after it had been “shaped” to do the opposite. Thus a standard pillow is not an effective tool to prevent pressure sores of the heel.
Another approach is to use a specially shaped foam wedge to support the lower legs. Foam wedges have an advantage over a soft pillow because the foam material maintains a specific shape, and it will not easily move out of place with shifting of the patient. A number of heel supporting wedges are available and most have a square shape, with a thickness high enough to elevate the heel well above the bed. Some of the foam wedges are shaped with a sloping angle so as to provide support under the knees and thighs.
Although these wedges serve to elevate the feet, often well above the heart, they have a number of shortcomings.
First, these types of wedges are too thick. Although the heel floating wedges available now can accomplish an elevation of the entire lower limb, they are well over 12″ thick. The wedges are so high that the wedge must be removed when the patient is turned to their side, which should occur at least every 2 hours. If the patient were to have a wedge this large under her body when on her side, her lower back/hips would be so twisted as to cause injury.
Another problem with the known foam wedges is the existence of long square edges. There are many patients who are not able to extend their legs to a full straight position due to musculoskeletal malformations, and thus cannot get a thick wedge all the way under their legs. Because of the solid shape of the wedge, if one limb is shorter than the other, only one heel can be floated. Square edges tend to be effective only when the patients' foot is angled at 90 degrees from the edge, which is not always a natural or comfortable position.
Another problem with the known foam wedges is that they address only floating the heels. Even if the patient could tolerate the wedge under the legs while on the side, the bony prominence of the ankles, the lateral and proximal malleolus, and of the feet, the medial and lateral sides of the phalanges, which are also common sites for pressure sores, are subject to pressure unless the entire foot was suspended off the wedge. Floating the entire foot causes a transfer of weight uncomfortable to the ankle joint, putting undue stress on the ankle and subsequent injury.
Another problem with the known foam wedges is that they are too big. Wedges tend to be bulky and cumbersome, making them awkward for a care giver to position, and for a hospital to store when not in use. Many are designed to support the entire lower limb up to the patient's buttocks. They can impede with the care of the patient during cleaning and are susceptible to soiling. Contrary to hospital pillows, they cannot be covered easily with a standard pillow case, so when soiled, they cannot simply remove the pillowcase and throw it in the laundry then wipe it down as they do with pillows. Indeed, a large wedge is difficult and inconvenient to rinse off under a running faucet. These factors are enough to discourage a rushed caregiver to use the known foam wedges.
There have been attempts to address some of the above shortcomings. An example of a foam cushion which addresses some of the above described shortcomings is disclosed in U.S. Pat. No. 6,634,045 to DuDonis and shown in FIG. 1.
However, despite the availability of some of the known pillows and foam wedges, a heel support for floating the heels from the bed in multiple patient orientations and without the above identified problems is still desired.